Psychological Medicine, 1983, 13, 595-605

Printed in Great Britain

The Brief Symptom Inventory:

an introductory report
LEONARD R. DEROGATIS1 AND NICK MELISARATOS
From the Department of Psychiatry, Johns Hopkins University School of Medicine,
Baltimore, Maryland, USA

SYNOPSIS This is an introductory report for the Brief Symptom Inventory (BSI), a brief
psychological self-report symptom scale. The BSI was developed from its longer parent instrument,
the SCL-90-R, and psychometric evaluation reveals it to be an acceptable short alternative to the
complete scale. Both test-retest and internal consistency reliabilities are shown to be very good for
the primary symptom dimensions of the BSI, and its correlations with the comparable dimensions of
the SCL-90-R are quite high. In terms of validation, high convergence between BSI scales and like
dimensions of the MMPI provide good evidence of convergent validity, and factor analytic studies
of the internal structure of the scale contribute evidence of construct validity. Several criterion-
oriented validity studies have also been completed with this instrument.

Data rising from these measures may also be

PSYCHOLOGICAL ASSESSMENT BY directly incorporated into the clinical decision
SELF-REPORT systems (Fowler, 1969; Glueck & Stroebel, 1969;
Assessment of the psychological status of Lanyon, 1972, 1974), and self-report inventories
individuals by self-reports dates back to the First have been shown to be sensitive to a wide variety
World War, and the development of the of therapeutic interventions (Kellner, 1971;
Personal Data Sheet by Woodworth (1918). Lyerly & Abbott, 1964).
Woodworth's scale provided a means for each It should also be appreciated, however, that
man to 'interview himself and created a the self-report method tacitly assumes the validity
historical benchmark for a new modality of of the 'inventory premise', i.e. the assumption
psychological measurement. that the individual being assessed can and will
The self-report mode of assessment possesses accurately describe his current symptoms and
a number of unique advantages and characteris- behaviour (Wilde, 1972), a premise which cannot
tics to recommend it, as well as several inherent always be supported. Social desirability
weaknesses. The first advantage, particularly (Edwards, 1957) and extreme response styles
concerning psychopathology, is the accessibility (e.g. aquiescence) can contribute to systematic
of exclusive information that is ordinarily distortions, although careful work has produced
unavailable through other methods of evaluation. some serious doubts about the size and
Self-report measures reflect information derived pervasiveness of these effects (Block, 1965;
directly from the person experiencing the Fiske, 1971; Rorer, 1965).
phenomena, namely the patient himself. Sec- In spite of concerns about its deficiencies, the
ondly, there is the economy of professional time self-report method remains a useful form of
involved with the use of self-reports. The clinical measurement and, as Nunnally (1978,
technique can be integrated into institutional p. 141) has stated, 'even though self-inventories
routines with relative ease and is amenable to definitely have their problems as approaches to
actuarial methods of scoring and interpretation. the measurement of personality characteristics,
attitudes, values, and a variety of other
1
Address for correspondence: Dr L. R. Derogatis, Division of non-cognitive traits, they represent by far the
Medical Psychology, Department of Psychiatry, Johns Hopkins best approach available'.
University School of Medicine, Adolf Meyer Building, Room 200,
600 N. Wolfe Street, Baltimore, MD 21205, USA.

595 20-2
596 L. R. Derogatis and N. Melisaratos

dimensions or constructs. A brief definition of

THE BRIEF SYMPTOM INVENTORY
(BSI)
The Brief Symptom Inventory (Derogatis, 1975)
is a 53-item self-report symptom inventory
designed to assess the psychological symptom
status of psychiatric and medical patients, as well
as individuals who are not patients. The BSI is
essentially the brief form of the SCL-90-R, a
self-report inventory that has been developed
and used in a wide variety of settings and
applications (Derogatis et al. 1976; Derogatis,
1977). The instrument comprises 53 items
selected to reflect best the 9 primary symptom
dimensions of the SCL-90-R in a brief measure-
ment scale. In addition to the 9 primary
symptom dimensions, there are three global
indices of distress associated with the BSI: the
General Severity Index (GSI), the Positive
Symptom Distress Index (PSDI), and the
Positive Symptom Total (PST). These same three
summary measures are also utilized by the
SCL-90-R, each communicating psychological
distress in a somewhat different fashion (Dero-
gatis et al. 1975).
Scale characteristics
Each item of the BSI is rated on a 5-point scale
of distress (0-4), ranging from 'not-at-all' to
'extremely'. Test administration ordinarily takes
less than 10 minutes, 1-2 minutes being devoted
to the introduction of theinstrument. Instructions
preceding the inventory are brief and worded in
simple language, as are the 53 test items. A
primary consideration in item development was
the selection of phrasing and language that
would be understood by a wide segment of the
population and still retain the intended item
meaning. The Thorndike-Lorge Word Book
(1944) was used to equate the vocabulary levels
of the 9 primary dimensions and to keep the
general vocabulary as basic as possible. In
general, the BSI can be used with individuals who
have reached a reading knowledge equivalent to
that of an American sixth grade education. In
terms of age limitations, adolescents as young as
13 years have been evaluated via the BSI without The hostility dimension is organized around
apparent distortions.
Dimensional structure of the BSI
The BSI, like its parent instrument the SCL-90-R, break things, frequent arguments and uncontrol-
is conceived as measuring 9 primary symptom lable outbursts of temper.
each construct is provided in the sections below.
I. Somatization (SOM)
This dimension reflects psychological distress
arising from perception of bodily dysfunction.
Complaints typically focus on cardiovascular,
gastrointestinal, respiratory and other systems
with strong autonomic mediation. Aches and
pains, and discomfort localized in the gross
musculature are also frequent manifestations.
II. Obsessive-compulsive (O-C)
The focus of this dimension is on thoughts and
actions that are experienced as unremitting and
irresistible by the patient but are of an ego-alien
or unwanted nature. Examples are: having to
check and double-check actions, difficulty in
making decisions, and trouble concentrating.
III. Interpersonal sensitivity (IS)
This dimension focuses on feelings of personal
inadequacy and inferiority. Self-deprecation,
feelings of uneasiness, and marked discomfort
during interpersonal interactions are characteris-
tics of persons with high levels of interpersonal
sensitivity.
IV. Depression (DEP)
Depression reflects a broad range of signs and
symptoms of the clinical depressive syndromes.
Symptoms of dysphoric affect and mood,
withdrawal of interest in life activities, and loss
of vital energy are reflected by this dimension, as
are feelings of hopelessness and futility.
V. Anxiety (ANX)
The anxiety dimension subsumes a set of
symptoms usually associated clinically with high
manifest anxiety. Restlessness, nervousness and
tension are all indicative of anxiety, as are
experiences reflecting free-floating anxiety and
panic.
VI. Hostility (HOS)
three categories of hostile behaviour: thoughts,
feelings, and actions. Typical experiences cover
feelings of annoyance and irritability, urges to
 Brief Symptom Inventory
VII. Phobic anxiety (PHOB)
The symptoms that comprise this dimension
have been observed to occur frequently in
conditions usually termed phobic anxiety states
or agoraphobia. Phobic fears oriented towards
travel, open spaces, crowds, public places or
conveyances are all represented by this
dimension.
VIII. Paranoid ideation (PAR)
The present definition of paranoid ideation rests
on the assumption that paranoid behaviour is
most accurately viewed as syndromal in nature.
Paranoid phenomena are conceived as a mode of
thinking. The primary characteristics of paranoid
thought are projection, hostility, suspiciousness,
centrality, and fear of loss of autonomy.
IX. Psychoticism (PSY)
The present definition of psychoticism represents
it as a continuum, progressing from a mildly
alien life style at one extreme to floridly
psychotic status at the other. Signs of a schizoid,
alienated style of life are represented by this
dimension as are dramatic symptoms of
psychosis. In most non-psychiatric populations
this dimension measures social alienation.
Additional items
There are 4 items of the BSI which are not
subsumed under any of the primary symptom
dimensions; these symptoms 'load' on several
dimensions, but are not unique to any of them.
They are retained in the test because they
represent important vegetative and other clinical
indicators.
Global indices of distress
There are three global indices of distress
associated with the BSI: the General Severity
Index (GSI), the Positive Symptom Distress
Index (PSDI), and the Positive Symptom Total
(PST). The function of each of these global
measures is to communicate in a single score the
level or depth of symptomatic distress currently
experienced by the individual. The GSI is the
single best indicator of current distress levels,
and should be utilized in most instances where
a single summary measure is required. The GSI
combines information on the numbers of
symptoms and the intensity of perceived distress.
597
The PSDI is a pure intensity measure, in a sense
'corrected' for the numbers of symptoms. It
functions very much as a measure of response
style, communicating whether the patient is
'augmenting' or 'attenuating' distress in his/her
manner of reporting. The PST is simply a count
of the symptoms which the patient reports
experiencing to any degree. The PSDI and the
PST are used in conjunction with the GSI to gain
a more meaningful understanding of the clinical
picture.
Normative development of the BSI
A fundamental procedure for the interpretation
of an individual's psychological test performance
is the comparison of the patient's scores or
profile with some relevant group of individuals
who have also completed the test. Typically, the
larger the normative group of subjects, the more
representative the sample will be of the population
of interest.
There are 3 published norms available for the
BSI. These are based upon: (a) a sample of 1002
heterogeneous psychiatric out-patients; (b) a
sample of 719 non-patient normal subjects; and
(c) a sample of 313 psychiatric in-patients.
The psychiatric out-patient norm comprised
425 males and 577 females who represent
psychiatric out-patients presenting for initial
evaluation at four treatment facilities: (1) the
Out-patient Psychiatry Division of the Johns
Hopkins Medical Institutions; (2) the Out-patient
Psychiatry Division of the University of Maryland
School of Medicine; (3) the Out-patient Psychi-
atry Clinic of the Hospital of the University of
Pennsylvania; and (4) the Out-patient Psychiatry
Division of the University of Wisconsin School
of Medicine.
The non-patient norm is based upon the
responses of 344 males and 341 females. It
represents a stratified random sample from a
single county in one of the large eastern states.
The psychiatric in-patient norm is based on the
intake scores of 115 males and 198 females who
were admitted as in-patients to the Phipps Clinic,
Johns Hopkins Hospital. All of these patients
were evaluated during the first week following
admission.
Interpretation of the BSI
Both the BSI and the SCL-90-R are designed for
interpretation at three distinct but related levels.
598 L. R. Derogatis and N. Melisaratos

Table 1. Demographic characteristics (%) of psychiatric out-patient (N = 1002), psychiatric

in-patient (N = 310) and non-patient subject (N = 719) normative samples for the BSI
Variable Psychiatric out-patient Psychiatric in-patient Non-patient

Age (mean±s.D.) 31O2± 121 33-31 ±14-85 4600 ±14-7

Sex
Male 42-4 370 50-7
Female 57-6 630 49-3
Race
White 671 55-7 86-8
Black 32-6 43-6 11-6
Other — 0-8 —
Marital Status
Single 45-7 44-5 —
Married 32-4 26 1 —
Other 21-6 29-3
Single or married — — 84-6
Divorced — — 15-4
Religion
Catholic 32-7 24-8 —
Protestant 363 64-8 —
Jewish 7-3 5-3
Other 23-4 50 —
Social class
I 4-3 2-3
II 7-8 2-6
III 24-2 16-2
IV 30-8 44-5 —
V 32-4 34-3 —

Initially, interpretation should focus on the
global scores to gain an appreciation of the
degree of overall distress. The evaluation should
then be refocused to integrate information at the
level of the primary symptom dimensions. The
BSI primary symptom dimensions are designed
to provide a 'broad brush' profile of the
respondent which can delineate and underline
specific areas of psychopathology. A more
specific focus is provided at the level of the
discrete symptoms; these individual items com-
municate detailed symptomatic manifestations
which often further enhance and amplify the
clinical decision process.
The 9 primary symptom dimensions essentially
provide a profile of the patient's psychological
status in psychopathological terms. They com-
municate information on the nature and intensity
of the patient's distress, and provide data
concerning the pattern of the patient's sympto-
matology. Table 2 and Fig. 1 depict the mean raw
scores on the 9 primary symptom dimensions
and the 3 global indices in tabular and graphical
forms for three normative clinical groups.
Fig. 1 depicts the BSI symptom profiles of the
1002 psychiatric out-patients and 310 psychiatric
in-patients plotted against the non-patient norm.
Focusing on the global indices first, the GSI for
both groups of patients is two standard
deviations above the normative mean. This
magnitude of distress places the mean patient at
the 98th centile of the non-patient norm. The
PSDI and PST are each elevated about 1-6
standard deviations, placing these groups in the
95th centile of the norm. The 9 symptom
dimensions of the patient profiles are all clearly
elevated, ranging from 1-3 to 2-3 standard
deviations above the normative means.
Reliability of the BSI
The reliability estimates for the 9 symptom
dimensions and the 3 global indices of the BSI
are essentially of two types: internal consistency
and test-retest reliability. The former serves to
measure the homogeneity or consistency of the
items selected to represent each symptom
construct. Test-retest reliability is essentially an
indicator of the stability of the measurement
across time. Table 3 provides internal consistency
(alpha) coefficients for the 9 symptom dimensions
 Brief Symptom Inventory 599

Table 2. Mean raw scores on the 9 primary symptom dimensions and the 3 global indices of the
BSI for psychiatric out-patients, psychiatric in-patients and non-patient normals
Psychiatric out- Psychiatric in-
patients patients Non-patients
(mean±S.D.) (mean±s.D.) (mean±s.D.)

Symptom dimension
I. SOM 0-83 ±0-80 101 ±0-91 0-29 ±0-40
II. O-C •57+1-00 1-51 ±1-07 0-43 ±0-48
III. I-S 58±1O5 1 -48 ±1-11 0-32 ±0-48
IV. DEP •80+108 1-77±1-21 0-28 ±0-46
V. ANX •70 ±1-00 l - 7 0 ± 1-15 0-35±0-45
VI. HOS •16±0 93 1 00 ±0-97 0-35±0-42
VII. PHOB ()-86±0-88 1 -07 ±1-11 0 1 7 ± 0 36
VIII. PAR •14±0-95 1-26 ±1-02 0-34±0-45
IX. PSY •19±0-87 l-26±0-98 0 15±0-31
Global indices
GSI l-32±0-72 l-36±0-86 O-3O±O-31
PSDI 215±0-61 2-16 ±0-73 l-29±0-41
PST 30-80 ± 11-63 30-60± 13-40 11 -45 ±9-29

See text for a definition of abbreviations.

80

60-- --84

§ 55-- --70
H
50

45-- --30

40-- --16

35-- --7

30 4- -4- 2
SOM O-C +
I-S DEP ANX HOS PHOB PAR PSY GSI PSDI PST
FIG. 1. BSI symptom profiles for 1002 psychiatric out-patients (A # ) and 310 psychiatric in-patients ( 0 — 9 ) plotted against
the non-patient norm. Abbreviations are given in the text.

and test-retest coefficients for the 9 dimensions
and the 3 global measures.
The internal consistency reliability was estab-
lished on the sample of 1002 out-patients and
was determined by utilizing Cronbach's co-
efficient alpha (a). Alpha coefficients for all 9
dimensions ranged from a low of 0-71 on the
psychoticism dimension to a high of 0-85 for
depression.
Test-retest reliability reflects the stability or
consistency of measurement across time. As
longer periods of time elapse between measure-
ments, there is a greater opportunity for change to
be effected; stability coefficients are typically
related inversely to time elapsing between
administrations of the measure. The stability
coefficients listed in Table 3 were generated from
BSI data on a sample of 60 non-patient subjects
600 L. R. Derogatis and N. Melisaratos

Table 3. Internal consistency and test-retest Table 4. Correlations between like symptom
reliability coefficients for the 9 primary symptom dimensions of the SCL-90-R and the BSI based
dimensions and the 3 global indices of the BSI upon 565 psychiatric out-patients
Internal SOM 0-96 HOS 0-99
No. of consistency (a) Test-retest O-C 0-96 PHOB 0-97
items ( # = 719) I-S 0-94 PAR 0-98
DEP 0-95 PSY 0-92
Symptom dimension ANX 0-95
I. SOM 0-80 0-68
II. O-C 0-83 0-85
III. I-S 0-74 0-85
IV. DEP 0-85 0-84
V. ANX 0-81 0-79 Validity of the BSI
VI. HOS 0-78 0-81
VII. PHOB 0-77 0-91 Two major issues that should be appreciated
VIII. PAR 0-77 0-79 concerning the validity of psychological tests
IX. PSY 0-71 0-78
have to do with (a) the specificity of predictive
Global indices
GS1 0-90
validity, and (b) the programmatic nature of
PSDI 0-87 construct validation. The former issue refers to
PST 0-80 the observation that for the question ' Is this test
valid?' to have any scientific meaning, the
who were tested at a 2-week interval. Values conditional statement' For what purpose?' must
ranged from a low of 0-68 for somatization to a be appended.
maximum of 0-91 for phobic anxiety. The The second issue focuses on the fact that
stability coefficient for the GSI was 0-90, psychometric authorities have increasingly
strongly indicating that the BSI is a reliable stressed construct validity as the central criterion
measure over time. for the validation of psychological tests and the
Indices of stability for psychopathological assignment of meaning to these measures
syndromes ordinarily fall between those for (Messick, 1975, 1981). Such assertions demand
stable personality characteristics such as' intelli- an extensive programme of related experiments
gence' and more labile attributes such as that are analogous to the steps necessary for the
'mood'. The 9 dimensions of the BSI reflect high proof of scientific theory. Data from predictive,
levels of stability, with dimensions regarded as content, convergent, discriminant and other
being more state-determined, revealing some- types of validation studies contribute to the
what lower coefficients than those mediated ultimate validation of the hypothetical construct
more by the characterological (trait) structure of that the test serves to operationalize. It is
the individual. important to realize that this process should be
Another traditional form of reliability for represented by an ongoing series of experiments
psychological tests is that of alternate forms. that constantly extend and redefine the limits of
Alternate forms reliability is represented by the generalizability of the test as a definition of the
construct.
correlation between score distributionsdeveloped
from two different forms of the test, usually
administered within approximately 1-2 weeks of Convergent and discriminant validity
each other. Although the BSI and the SCL-90-R As Campbell & Fiske (1959) have demonstrated,
are not strictly speaking' alternate forms' of the convergent and discriminant relationships be-
same test, they do represent two tests measuring tween operational measures of constructs (e.g.
the same symptom constructs. For this reason psychological tests) and other operational mea-
we felt that correlations between the two would sures are necessary to establish the network that
provide useful data, and have presented them in forms the basis of construct validation. In simple
Table 4, based upon the responses of 565 terms, the concept requires that scores from a test
psychiatric out-patients. Correlations between designed to measure a particular construct
the two are uniformly very high across all 9 should correlate highly with other measures of
dimensions, demonstrating that they measure that construct, and show relatively low correla-
essentially the same symptom constructs. tions with measures of dissimilar constructs. Such
 Brief Symptom Inventory 601

Table 5. Correlations between BSI symptom dimensions and MMPI clinical, Wiggins (IV) and
Try on (T) scores*
I. Somatization Schizophrenia (MMPI) 0-48
Body symptoms (T) 0-38 Poor morale (W) 0-45
Hypochodriasis (MMPI) 0-37 Autism (T) 0-42
Organic symptoms (W) 0-36 Resentment and aggression (T) 0-41
Poor health (W) 0-33 Organic symptoms (W) 0-40
II. Obsessive-Compulsive Phobia (W) 0-40
Schizophrenia (MMPI) 0-44 VI. Hostility
Psychasthenia (MMPI) 0-44 Resentment and aggression (T) 0-56
Depression (W) 0-39 Manifest hostility (W) 0-48
Organic symptoms (W) 0-38 Depression (W) 0-42
Autism (T) 0-38 Suspicion and mistrust (T) 0-35
Resentment and aggression (T) 0-36 Family problems (W) 0-35
III. Interpersonal Sensitivity Anxiety (T) 0-31
Poor morale (W) 0-63 VII. Phobic Anxiety
Psychasthenia (MMPI) 0-55 Phobias (W) 0-45
Introversion (T) 0-52 Psychasthenia (MMPI) 0-35
Schizophrenia (MMPI) 0-49 Anxiety (T) 0-30
Depression (T) 0-48 Poor morale (W) 0-30
Depression (W) 0-47 Depression (W) 0-30
Social maladjustment (W) 0-47 VIII. Paranoid Ideation
Social introversion (MMPI) 0-44 Suspicion and mistrust (T) 0-47
IV. Depression Resentment and aggression (T) 0-42
Depression (W) 0-72 Manifest hostility (W) 0-41
Depression (T) 0-67 Family problems (W) 0-41
Poor morale (W) 0-57 Paranoia (MMPI) 0-35
Schizophrenia (MMPI) 0-52 Autism (T) 0-35
Resentment and aggression (T) 0-52 IX. Psychoticism
Psychasthenia (MMPI) 0-46 Schizophrenia (MMPI) 0-48
Anxiety (J) 0-45 Psychopathic deviate (MMPI) 0-40
Autism (T) 0-43 Poor morale (W) 0-39
V. Anxiety Psychoticism (W) 0-38
Anxiety (T) 0-57 Psychasthenia (MMPI) 0-38
Depression (W) 0-48 Autism (T) 0-37
Psychasthenia (MMPI) 0-48 Paranoia (MMPI) 0-32

• Correlations below 0-30 are omitted.

a pattern of relationships should hold if the test
is to be considered a valid reflection of the
construct under consideration.
A previous study, based on a sample of 209
symptomatic volunteers, demonstrated impres-
sive convergent validity for the SCL-90-R with the
MMPI (Derogatis et al. 1976). Since the 53 items
of the BSI are contained within the SCL-90-R,
the data set was re-analysed, scoring for the BSI
instead of the SCL-90-R. Table 5 contains the
correlational results of this re-analysis, listing
coefficients ^ 0-30 between the 9 dimensions of
the BSI, and (1) the clinical scales of the MMPI
(Dahlstrom, 1969), (2) the Wiggins Content
Scales of the MMPI (Wiggins, 1966), and (3) the
Tryon Cluster Scores (Tryon, 1966).
In the original SCL-90-R study (Derogatis et
al. 1976), 8 of the dimensions of the SCL-90-R
demonstrated directly convergent counterparts
among the 30 MMPI scales evaluated, and all 8
dimensions showed excellent convergence (e.g.
Somatization with' Body symptoms', Depression
with 'Depression' and Paranoid Ideation with
'Suspicion and mistrust'). Even the Obsessive-
Compulsive dimension, for which there is no
truly analogous construct among the MMPI
scales, revealed a pattern of maximal correlations
(i.e. Schizophrenia, Organic symptoms, Psychas-
thenia) which is highly consistent with the
definition of the clinical construct.
The current re-analysis, in terms of the BSI,
also revealed excellent convergence, although in
the case of several dimensions the overall
magnitudes of correlations were somewhat
reduced. Interpersonal Sensitivity, Depression,
Anxiety, Hostility, Phobic Anxiety, Paranoid
Ideation and Psychoticism all demonstrated
maximum correlations with MMPI scales that
were clearly convergent (see Table 5). The
magnitudes of maximal correlation coefficients
602 L. R. Derogatis and N. Melisaratos
for the former three were almost identical with
those in the SCL-90-R study. In the cases of the
latter four measures, the magnitudes of correla-
tions were reduced by about 010, although the
pattern of correlations remained very similar in
the two studies. In the cases of the Somatization
and Obsessive-Compulsive dimensions, although
the patterns of correlations were retained, the
magnitudes of coefficients decreased by approxi-
mately 015. Apparently, items deleted from the
shorter form of the test were more important for
convergence with the MMPI in these dimensions
than in the other 7 measures.
The general finding of high convergence for
the dimensions of the BSI with MMPI scales,
although not unexpected, confirms the fact that
the reduction of the length of the SCL-90-R
dimensions has not had a significant effect upon
their validity. Reductions in the magnitude of
coefficients almost certainly reflect some loss of
reliability associated with shortening the scales,
but convergent patterns of relationship remain
clearly in evidence.
Internal structure and construct validity
Particularly when dealing with multidimensional
tests, the issue of internal structure is also critical
to the question of construct validation. If the test
is designed to measure a certain number of
dimensions or constructs defined via specified
series of item sets, then the dimensions defined in
this way should emerge in the analysis of a
representative empirical problem. The technique
usually employed to test the equivalence of
hypothetical versus empirical test structures is
factor analysis, and we have utilized the method
here in a similar fashion.
To assess the reproducibility of the internal
structure of the BSI, the scores of the psychiatric
out-patient sample (N = 1002) described earlier
were subjected to a principal components
analysis with 100s on the diagonal of the
correlation matrix. The correlation matrix
analysed was 49 x 49, omitting the 4 'additional'
items in the test since they are not hypothesized
to have univocal loadings on any of the 9
primary BSI dimensions. Nine interpretable
factors were derived from a normal varimax
rotation of the principal components (Harman,
1967), which accounted for 44% of the variance
in the matrix. A detailed representation of the
factor loadings ^ 0-35 is given in Table 6.
The first factor generated was essentially the
Psychoticism factor, with 4 of the 5 items
comprising the hypothesized dimension found to
load on the empirically derived factor. Two items
assigned to the Interpersonal Sensitivity dimen-
sion also correlated highly on this factor; so did
one item from the Depression dimension.
The second factor to emerge from the analysis
was the Somatization factor, with all 7 hypothe-
sized items showing marked correlations with the
dimension. Loadings were high, and the pattern
was consistent with previous confirmatory factor
analysis of the SCL-90-R (Derogatis & Cleary,
1977 a). Analogous findings were observed with
Hostility (Factor IV), Obsessive-Compulsive
(Factor VI), and Paranoid Ideation (Factor VII),
which also revealed well-saturated loadings for
all items derived from the a priori rational
structure.
Among the anxiety measures, loadings on the
dimension of Phobic Anxiety were substantial
and the hypothesized pattern was intact, except
for the item' feeling nervous when you are alone'
which did not correlate in this sample. An
additional item from the Interpersonal Sensitivity
dimension, 'feeling very self-conscious with
others', also loaded on the Phobic Anxiety
dimension. The general Anxiety dimension split
into two more specific component dimensions
that were labelled 'panic anxiety' (Factor VII)
and 'nervous tension' (Factor IX), afindingthat
was evident to a lesser degree in the confirmatory
SCL-90-R study alluded to above (Derogatis &
Cleary, 1977 a).
The Depression dimension (Factor III) was
well defined in the present instance, with only one
item, 'feelings of worthlessness', showing a high
loading on another factor. In addition, the
fourth of the Interpersonal Sensitivity items was
also observed to load on the Depression factor.
There is no obvious explanation why the
Interpersonal Sensitivity dimension was not
reproduced in the present study. This dimension
has been consistent and invariant in the context
of both the SCL-90-R (Derogatis & Cleary,
1977 a, b) and its predecessor, the Hopkins
Symptom Checklist (Derogatis et al. 1972,1974).
It is possible that some peculiarity of the sample
composition acted to 'unravel' the linear
composition of this dimension; however, it
should also be appreciated that 4 items (the
smallest factor in the BSI) may simply be too few
 Brief Symptom Inventory 603

Table 6. Orthogonal varimax loadings for 9 factors determined from a principal components
analysis of 49 items of the BSI
Symptom Symptom Symptom
dimension Loading dimension Loading dimension Loading

I. Psycholicism II. Sotnatization III. Depression

3. The idea that someone else — 2. Faintness or dizziness 0-45 9. Thoughts of ending your life 0-42
can control your thoughts 7. Pains in heart or chest 0-50 16. Feeling lonely 0-65
14. Feeling lonely even when 0-54 23. Nausea or upset stomach 0 44 17. Feeling blue 0-64
you are with people 29. Trouble getting your breath 0-64 18. Feeling no interest in things 0-57
34. The idea that you should 0-42 30. Hot or cold spells 0-62 35. Feeling hopeless about the 0-36
be punished for your sins 33. Numbness or tingling in future
44. Never feeling close to 0-45 parts of your body 0-56 50. Feelings of worthlessness 0-35
another person 37. Feeling weak in parts of 060 20. Your feelings being easily 0-42
53. The idea that something 0-48 your body hurt
is wrong with your mind
22. Feeling inferior to 0-51
others
42. Feeling very self- 0-47
conscious with others
50. Feelings of worthlessness 0-63

IV. Hostility V. Phobic Anxiety VI. Obsessive-Compulsive

6. Feeling easily annoyed or 0-42 8. Feeling afraid in open 0-44 5. Trouble remembering things 0-62
irritated spaces 15. Feeling blocked in getting 0-37
13. Temper outbursts that 0-63 28. Feeling afraid to travel 0-56 things done
you could not control on buses, subways or 26. Having to check and
40. Having urges to beat, 0-56 trains double-check what you do 0-48
injure or harm someone 31. Having to avoid certain 0-44 27. Difficulty making decisions 0-43
41. Having urges to break or 0-57 things, places or 32. Your mind going blank 0-53
smash things activities because they 36. Trouble concentrating 0-53
46. Getting into frequent 0-64 frighten you
arguments 43. Feeling uneasy in crowds 0-66
47. Feeling nervous when you —
are alone
42. Feeling very self-conscious 044
with others

VII. Anxiety VIII. Paranoid Ideation IX. Anxiety

1. Nervousness or shakiness — 4. Feeling others are to blame 0-37 1. Nervousness or shakiness 0-45
inside for most of your troubles inside
12. Suddenly scared for no 0-54 10. Feeling that most people 0-59 12. Suddenly scared for no —
reason cannot be trusted reason
19. Feeling fearful 0-57 24. Feeling that you are 0-56 19. Feeling fearful —
38. Feeling tense or keyed — watched or talked about by 38. Feeling tense or keyed up 0-71
up others 45. Spells of terror
45. Spells of terror or 0-49 48. Others not giving you 0-35 or panic —
panic proper credit for your 49. Feeling so restless you 0-35
49. Feeling so restless you — achievements couldn's sit still
could not sit still 51. Feeling that people will 0-53
take advantage of you if
you let them
21. Feeling that people are 0-54
unfriendly or
dislike you

to sustain invariance across important population
parameters (Gorsuch, 1966).
Although there are certain minor differences
between the empirical factor structure and the
dimensional structure rationally hypothesized,
there is more agreement than disagreement
between the two. Essentially, 7 of the 9
hypothesized symptom constructs were repro-
duced with little or no disjuncture of items; an
eighth dimension simply split into two well-
defined clinical component dimensions. The
ninth dimension did not stay together as a linear
combination, but the set of only 4 items that
define this dimension may well be too small to
604 L. R. Derogatis and N. Melisaratos
ensure invariance. It may be necessary to add
two or three additional items from the dimension
as defined in the SCL-90-R. Results from the
structure-comparing factor analysis lend strong
additional weight to the construct validation of
the BSI.
Predictive validity
In spite of the scientific value of construct
validation, the average clinician/investigator is
usually interested in the more practical side of
test validity, i.e. predictive validity. Most test
users are interested in the practical issues of how
well a test can register changes in psychological
status arising from mental disorders, treatment
interventions, stress-inducing life events, or a
host of other factors. The sensitivity of a
measuring instrument to factors effecting such
changes is reflected in its correlations with
various relevant criterion measures which, in
turn, represent summary statements concerning
its specific predictive validities.
Although during the 1970s research with the
SCL-90-R tended to take precedence over work
with the BSI in our laboratory, this situation has
now changed substantially. Several predictive
validation studies with the BSI will soon be
completed, and a number of other investigators
have also begun to use the brief form of the scale.
Several have published reports showing high
sensitivity for the BSI. Marshal & Bougsty (1981)
have published an interesting epidemiological
report on psychological disorders in one com-
munity, and Amenson & Lewinsohn (1981) have
completed a detailed investigation of sex differen-
ces in unipolar depression with the BSI. Kremer
& Atkinson (1981) have shown high convergent
validity for the BSI with a number of other scales
in predicting affective status among chronic pain
patients, and Peterson and his colleagues (1981)
have reported the BSI to have substantial
predictive value in a counselling centre popula-
tion. The utilization of the BSI in a broad range
of substantive contexts indicates that a number
of additional criterion-oriented validity studies
will soon be forthcoming.
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